Nearly half of women surveyed in a northern Vietnamese province had had symptoms of reproductive tract infection within the previous six months, but only about two-thirds of these had sought medical care.1 One-quarter of women with symptoms ignored them, and one in 10 treated themselves. Women who did not perceive their symptoms as signs of illness and women whose symptoms were mild were among those with elevated odds of ignoring their symptoms. Although not all reproductive tract infections are acquired sexually, women who attached stigma to sexually transmitted infections (STIs) also had an increased likelihood of ignoring symptoms.

The survey was conducted in 1998 among a randomly selected sample of women aged 18-49 living in two villages--one urban and one rural--in Hai Phong Province. Virtually all (99%) of the 1,163 participants were married, and about half were using modern contraceptives; the IUD and condoms accounted for the bulk of modern method use (51% and 31%, respectively). Half of the women had had at least one abortion.

Participants reported little in the way of behavior that would increase their risk of STIs. Only 1% said that they had had premarital sex, and 2% reported having had more than one partner. Likewise, 95% said that their husband had never had another partner, and 4% had ever seen a potential STI symptom in their husband. Most of the women believed that individuals who contract STIs are personally responsible for their infection and that getting an STI would make them feel ashamed.

Forty-four percent of participants reported that within the previous six months, they had had at least one symptom of reproductive tract infection on a list created by the researchers. In this group of women, 78% had had abnormal vaginal discharge, 47% lower abdominal pain, 35% genital itching and 15% pain during intercourse. Smaller proportions (1-4%) reported a variety of other symptoms.

Overall, 64% of women who had had symptoms suggesting the presence of a reproductive tract infection had sought medical care: 25% from a local health station, 16% from a hospital, 15% from a pharmacy and 8% from a private doctor. While 11% had treated themselves, 25% had ignored their symptoms.

Using stepwise logistic regression analysis, the researchers explored the factors that were independently associated with ignoring symptoms of reproductive tract infection. The results showed that women who did not link their symptoms to the possibility of infection were significantly more likely than those who did to neither seek medical care nor treat themselves (odds ratio, 3.6); the odds of ignoring symptoms also were elevated among women who had experienced no or mild itching (3.0) and those who had first noticed symptoms within the past week (2.5).

Two social factors also were associated with an increased likelihood of ignoring symptoms: not having sought advice about the symptoms from one's support network (odds ratio, 2.9) and stigmatizing STIs (1.8). Women whose husbands traveled more than eight weeks a year were significantly less likely than those whose husbands spent less time away from home to ignore symptoms (0.3).

Successful management of reproductive tract infections, the researchers comment, "hinges on women's interpretation of and health-seeking behavior for...symptoms." Thus, the investigators recommend the development of interventions to raise awareness of these infections and their health consequences. They also stress the importance of education focused on reproductive tract infections that are not transmitted sexually, as a means of reducing stigma and thereby encouraging women to seek treatment for symptoms.--D. Hollander